Summary of Position

• Receive, answer and/or record telephone/correspondence/e-mail inquiries from subscribers, providers, and other consumers relating to areas of coverage, payment of claims, membership status, medical management intake calls, etc., under the various EmblemHealth medical/surgical, dental, hospital and Medicare plans.

Principal Accountabilities

• Review inquiries, correspondence and email receipts. Prepare email resolutions, letters (form or narrative letter) and/or claims payment process adjustments.
   
• Perform written and verbal duties of the position to meet company goals for production and accuracy.
   
• Perform related claims approving and clerical work as assigned.
   
• Perform other duties as assigned or required.
   
• Regular attendance is an essential function of the job

Qualifications

Education, Training, Licenses, Certifications

• A college degree is preferred

Relevant Work Experience, Knowledge, Skills, and Abilities

• A minimum of two (2) years’ experience in customer service; one year must be in a call center setting
   
• Health insurance experience is a plus
   
• Must be able to work under pressure, handle stressful situations effectively and deal politely with subscribers and providers on the telephone, in person, and email/correspondence
   
• Ability to detect and relate problem service issues to management
   
• Ability to speak well on the telephone and maintain a positive telephone personality
   
• Must be able to compose clear concise letters
   
• If designated, sort and screen correspondence receipts and resolve via coding of additional payment, possibly including salvage and/or completion by letter
   
• Typing and PC skills
   
• Ability to adapt to change and address multiple issues simultaneously
   
• Good organizational skills
   
• Must be available for training